Type of fluids and volume expander


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Type of fluids and volume expander

  1. 1. Type of Fluids and VolumeExpanderNabilah060 100 814H4
  2. 2. Body Fluids CompositionTotal body water= 60% (male)|50%(female) x body wt = 0.5 X 70 = 35 litersECF=1/3 ICF=2/30.33 X 35 = 11.6 liters 0.66 X 35 = 23.3 litersBlood=1/4 (ECF)0.25 X 10.5 = 2.625 liters
  3. 3. Types of IV FluidsThree main types of IVF: Isotonic fluids Hypotonic fluids Hypertonic Fluids
  4. 4. Isotonic Fluids Osmolarity is similar to that of serum. These fluids remain intravascularly mommentarily, thus expanding the volume. Helpful with patients who are hypotensive or hypovolemic. Risk of fluid overloading exists. Therefore, be careful in patients with left ventricular dysfunction, history of CHF or hypertension.
  5. 5. 1 Liter 0.9% saline Total body waterECF=1 liter ICF=0 Interstitial=3/4 of ECF=750mlIntravascular=1/4 ECF=250 ml
  6. 6. Hypotonic Fluids Less osmolarity than serum (meaning: less sodium ion concentration than serum) These fluids DILUTE serum thus decreasing osmolarity. Water moves from the vascular compartment into the interstitial fluid compartment  interstitial fluid becomes diluted osmolarity decreases  water is drawn into adjacent cells. Less than 10% remain intravascular, inadequate for fluid resuscitation Caution with use because sudden fluid shifts from the intravascular space to cells can cause cardiovascular collapse and increased ICP in certain patients.
  7. 7. 1 liter 5% Dextose Total body water=1 liter ECF=1/3 = 300ml ICF=2/3 = 700mlIntravascular=1/4 of ECF~75ml
  8. 8. Hypertonic Fluids These have a higher osmolarity than serum. These fluids pull fluid and sometimes electrolytes from the intracellular/interstitial compartments into the intravascular compartments. Useful for stabilizing blood pressure, increasing urine output, correcting hypotonic hyponatremia and decreasing edema. These can be dangerous in the setting of cell dehydration.
  9. 9. 1 liter 5% Albumin Intravascular=1 liter
  10. 10. Two Main Groups of Fluids Crystalloids Colloids
  11. 11. Crystalloids Clear solutions –fluids- made up of water & electrolyte solutions; small molecules. These fluids are good for volume expansion. However, both water & electrolytes will cross a semi-permeable membrane into the interstitial space and achieve equilibrium in 2- 3 hours. Remember: 3mL of isotonic crystalloid solution are needed to replace 1mL of patient blood. This is because approximately 2/3rds of the solution will leave the vascular space in approx. 1 hour.
  12. 12. Crystalloids Continued Advantages: ◦ Inexpensive ◦ Easy to store with long shelf life ◦ Readily available with a very low incidence of adverse reactions ◦ Variety of formulations available that are effective for use as replacement fluids or maintenance fluids A major disadvantage is that it takes approximately 2-3 x volume of a crystalloid to cause the same intravascular expansion as a single volume of colloid.
  13. 13. Colloids Colloids are large molecular weight solutions (nominally MW > 30,000 Daltons) Macromolecular substances made of gelatinous solutions which have particles suspended in solution and do NOT readily cross semi-permeable membranes or form sediments. Their high osmolarity, are important in capillary fluid dynamics because they are the only constituents which are effective at exerting an osmotic force across the wall of the capillaries. These work well in reducing edema  draw fluid from the interstitial and intracellular compartments into the vascular compartments. Initially these fluids stay almost entirely in the intravascular space for a prolonged period of time
  14. 14. Colloids ContinuedThe general problems with colloid solutions are: Much higher cost than crystalloid solutions Small but significant incidence of adverse reactions Gelatinous properties  cause platelet dysfunction and interfere with fibrinolysis and coagulation factors thus possibly causing Coagulopathy in large volumes. These fluids can cause dramatic fluid shifts which can be dangerous if they are not administered in a controlled setting.
  15. 15. Common parenteral fluid therapySolutions Volumes Na+ K+ Ca2+ Mg2+ Cl- HCO3- Dextrose mOsm/LECF 142 4 5 103 27 280-310Lactated 130 4 3 109 28 273Ringer’s0.9% NaCl 154 154 3080.45% 77 77 154NaClD5W 50D5/0.45% 77 77 50 406NaCl3% NaCl 513 513 10266% 500 154 154 310Hetastarch5% 130- 130- 250,500 <2.5 330Albumin 160 16025% 130- 130- 20,50,100 <2.5 330Albumin 160 160